Blue Cross, NCH agree to set up new health-care group under Obamacare

NAPLES - Collier County residents insured by Blue Cross and Blue Shield could play a role in health-care reform, and may save money, as a result of a new contract with the NCH Healthcare System.

After months of talks, the Jacksonville-based Florida Blue and NCH have signed a three-year agreement to launch a program that ties medical services to incentives for being efficient and improving patients' health.

What Blue Cross and NCH have formed is a type of "accountable care organization," a new structure in which doctors and hospitals share responsibility for providing care to patients. Secondarily, they share a focus on improving the patient's health and being more efficient in the services provided.

The move toward accountable care organizations, ACOs, is one directive of health-care reform under the 2010 Affordable Care Act, often called Obamacare.

About 4,200 local residents insured with Florida Blue could be part of the program's first year of operation in 2013, according to the insurer.

"It's the first step toward helping patients add value to their health care," said Dr. Allen Weiss, president and chief executive officer of NCH.

The value means patients will get the medical care they need at the right time and setting, he said. When they take an active role in following their doctor's advice with preventive measures, the rewards are two-fold; improved health and the potential to save money.

Key in the structure is incentives to keep costs down by eliminating duplicated tests and other redundant services. Part of the arrangement is that Florida Blue will pass on some of the savings to the NCH group and to the beneficiaries by not hiking premiums in future years for their healthier behavior.

"Their premiums may not rise or potentially may go down," Weiss said. "As we get into prevention and keep them healthier, they need less care."

Patients won't see their premiums stay flat or go down until potentially the second year because Florida Blue has to track what changes are made in 2013.

To participate, Collier residents insured by Florida Blue must use any of the 64 physicians and nurse practitioners who are part of the NCH Healthcare Group and the NCH hospitals for their health care.

"Florida Blue will know where they are going (for their medical care)," Weiss said. "We are being monitored for quality programs. If at the end of the year Florida Blue is saving money, they will give some money back to the hospital and the patient's gain is reduced premiums and better health."

The collaborative and coordinated care model of ACOs is a dramatic change in how doctors, hospitals and all other medical providers will interact. The goal is to eliminate the current fragmented system of how patients are treated, which is costly and can mean poorer outcomes for patients.

"The physicians will spend more time with the patients and that leads to better outcomes," said Dr. Jonathan Gavras, senior vice president of delivery systems and chief medical officer of Florida.

Gavras said the expectation is that physicians will like the new accountable care structure because it allows them to get back to focusing on patients.

In July, U.S. Health and Human Services officials announced that 89 new accountable care organizations had been formed and started serving 1.2 million Medicare beneficiaries in 40 states.

Since last spring, Florida Blue has reached a similar contract with an oncology group with Baptist Health System in South Florida, Gavras said.

The ability to reach contract terms with NCH is because of a like-minded philosophy of wanting to move into an integrated system for patient services with a focus on prevention, officials involved in the agreement said.